Bipolar Adolescents Battle With Higher Risk for Substance Abuse

MENDOZA, ARGENTINA – All comorbid conditions increase the likelihood of substance abuse in adolescents with bipolar disorder, Dr. Harold I. Eist said at the Sixth World Congress on Depressive Disorders.

Many of the traits that characterize adolescence–such as impulsivity, rebelliousness, and curiosity–are intensified in bipolar teens. This is the case particularly in adolescents with comorbid attention-deficit hyperactivity disorder, said Dr. Eist, a psychiatrist in private practice in Bethesda, Md., and a past president of the American Psychiatric Association.

Furthermore, comorbidities such as conduct disorder or severe anxiety further exacerbate the condition, and some adolescents find it extremely difficult to resist the temptation of experimenting with substances.

Nearly 60% of the cases of bipolar disorder begin before the patient is 20 years old. Depending on the age of onset, adolescent bipolar disorder may look like childhood bipolar or adult bipolar disorder. Later-developing mania in adolescents is more likely to be euphoric, biphasic, and episodic, similar to adult mania.

Bipolar disorder in younger adolescents tends to be nonepisodic, chronic, and rapidly cycling, often ultradian and mixed. Early-onset bipolar disorder is characterized by severe irritability and affective storms, which are often violent. Euthymia is rare in early-onset bipolar disorder but common in the late-onset type.

In adolescents with early-onset bipolar disorder, 90% have ADHD, compared with 60% of adolescents who have later-occurring bipolar disorder.

Dr. Eist noted that adolescents with bipolar disorder who have had a significant manic episode will be less effective in school than they were before, and they won't know why. “These disorders are significant and should not be treated as if they were just aberrations of mood.”

The amount of time that an adolescent with bipolar disorder spends in mania or hypomania often is underestimated. Adolescents with bipolar disorder perceive hypomania and mild to moderate mania as normal, and recognize their condition only when they are in full mania. In addition, adolescents with bipolar disorder may experience euthymia as dull or boring.

It is important to keep in mind that adolescents are bad reporters, Dr. Eist said. “When they are depressed, they experience the depression as all consuming. They believe they have always been depressed and always will be depressed.” Adolescents with bipolar disorder are reluctant to keep mood charts, and if they do keep them, they are unlikely to be accurate. An independent assessment of the patient's mood is essential.

Protective factors in treating adolescents with bipolar disorder include positive support of an intact family, patient acceptance of psychotherapy and medication, patient cooperation with long-term therapy, high IQ, and little or no contact with the criminal justice system.

Substance abuse can be a “death sentence” for an adolescent with bipolar disorder, Dr. Eist said. Intervention is essential. “We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.”

'We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.' DR. EIST

MENDOZA, ARGENTINA – All comorbid conditions increase the likelihood of substance abuse in adolescents with bipolar disorder, Dr. Harold I. Eist said at the Sixth World Congress on Depressive Disorders.

Many of the traits that characterize adolescence–such as impulsivity, rebelliousness, and curiosity–are intensified in bipolar teens. This is the case particularly in adolescents with comorbid attention-deficit hyperactivity disorder, said Dr. Eist, a psychiatrist in private practice in Bethesda, Md., and a past president of the American Psychiatric Association.

Furthermore, comorbidities such as conduct disorder or severe anxiety further exacerbate the condition, and some adolescents find it extremely difficult to resist the temptation of experimenting with substances.

Nearly 60% of the cases of bipolar disorder begin before the patient is 20 years old. Depending on the age of onset, adolescent bipolar disorder may look like childhood bipolar or adult bipolar disorder. Later-developing mania in adolescents is more likely to be euphoric, biphasic, and episodic, similar to adult mania.

Bipolar disorder in younger adolescents tends to be nonepisodic, chronic, and rapidly cycling, often ultradian and mixed. Early-onset bipolar disorder is characterized by severe irritability and affective storms, which are often violent. Euthymia is rare in early-onset bipolar disorder but common in the late-onset type.

In adolescents with early-onset bipolar disorder, 90% have ADHD, compared with 60% of adolescents who have later-occurring bipolar disorder.

Dr. Eist noted that adolescents with bipolar disorder who have had a significant manic episode will be less effective in school than they were before, and they won't know why. “These disorders are significant and should not be treated as if they were just aberrations of mood.”

The amount of time that an adolescent with bipolar disorder spends in mania or hypomania often is underestimated. Adolescents with bipolar disorder perceive hypomania and mild to moderate mania as normal, and recognize their condition only when they are in full mania. In addition, adolescents with bipolar disorder may experience euthymia as dull or boring.

It is important to keep in mind that adolescents are bad reporters, Dr. Eist said. “When they are depressed, they experience the depression as all consuming. They believe they have always been depressed and always will be depressed.” Adolescents with bipolar disorder are reluctant to keep mood charts, and if they do keep them, they are unlikely to be accurate. An independent assessment of the patient's mood is essential.

Protective factors in treating adolescents with bipolar disorder include positive support of an intact family, patient acceptance of psychotherapy and medication, patient cooperation with long-term therapy, high IQ, and little or no contact with the criminal justice system.

Substance abuse can be a “death sentence” for an adolescent with bipolar disorder, Dr. Eist said. Intervention is essential. “We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.”

'We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.' DR. EIST

MENDOZA, ARGENTINA – All comorbid conditions increase the likelihood of substance abuse in adolescents with bipolar disorder, Dr. Harold I. Eist said at the Sixth World Congress on Depressive Disorders.

Many of the traits that characterize adolescence–such as impulsivity, rebelliousness, and curiosity–are intensified in bipolar teens. This is the case particularly in adolescents with comorbid attention-deficit hyperactivity disorder, said Dr. Eist, a psychiatrist in private practice in Bethesda, Md., and a past president of the American Psychiatric Association.

Furthermore, comorbidities such as conduct disorder or severe anxiety further exacerbate the condition, and some adolescents find it extremely difficult to resist the temptation of experimenting with substances.

Nearly 60% of the cases of bipolar disorder begin before the patient is 20 years old. Depending on the age of onset, adolescent bipolar disorder may look like childhood bipolar or adult bipolar disorder. Later-developing mania in adolescents is more likely to be euphoric, biphasic, and episodic, similar to adult mania.

Bipolar disorder in younger adolescents tends to be nonepisodic, chronic, and rapidly cycling, often ultradian and mixed. Early-onset bipolar disorder is characterized by severe irritability and affective storms, which are often violent. Euthymia is rare in early-onset bipolar disorder but common in the late-onset type.

In adolescents with early-onset bipolar disorder, 90% have ADHD, compared with 60% of adolescents who have later-occurring bipolar disorder.

Dr. Eist noted that adolescents with bipolar disorder who have had a significant manic episode will be less effective in school than they were before, and they won't know why. “These disorders are significant and should not be treated as if they were just aberrations of mood.”

The amount of time that an adolescent with bipolar disorder spends in mania or hypomania often is underestimated. Adolescents with bipolar disorder perceive hypomania and mild to moderate mania as normal, and recognize their condition only when they are in full mania. In addition, adolescents with bipolar disorder may experience euthymia as dull or boring.

It is important to keep in mind that adolescents are bad reporters, Dr. Eist said. “When they are depressed, they experience the depression as all consuming. They believe they have always been depressed and always will be depressed.” Adolescents with bipolar disorder are reluctant to keep mood charts, and if they do keep them, they are unlikely to be accurate. An independent assessment of the patient's mood is essential.

Protective factors in treating adolescents with bipolar disorder include positive support of an intact family, patient acceptance of psychotherapy and medication, patient cooperation with long-term therapy, high IQ, and little or no contact with the criminal justice system.

Substance abuse can be a “death sentence” for an adolescent with bipolar disorder, Dr. Eist said. Intervention is essential. “We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.”

'We keep treating the mania, but if we can't get the substance abuse problem under control, we lose the child.' DR. EIST